My vision for ideal medical care is a partnership between the physician, patient, and expanded healthcare team that tackles the root causes of chronic disease and tries to reverse and prevent these problems.

Dr. Bray Links

Friday, March 30, 2018

It was going to be a study that could change the American diet, a huge clinical trial that might well deliver all the medical evidence needed to recommend a daily alcoholic drink as part of a healthy lifestyle.

That was how two prominent scientists and a senior federal health official pitched the project during a presentation at the luxurious Breakers Hotel in Palm Beach, Fla., in 2014. And the audience members who were being asked to help pay for the $100 million study seemed receptive: They were all liquor company executives.

The 10-year government trial is now underway, and Anheuser Busch InBev, Heineken and other alcohol companies are picking up most of the tab, through donations to a private foundation that raises money for the National Institutes of Health.

The N.I.H., a federal agency, is considered one of the world’s foremost medical research centers, investing over $30 billion of taxpayer money in biomedical research each year. The vast majority of the funding goes to scientists outside the N.I.H., which manages the grants and provides oversight.

The alcohol study is overseen by the National Institute on Alcohol Abuse and Alcoholism, one of 27 centers under the N.I.H. The lead investigator and N.I.H. officials have said repeatedly that they never discussed the planning of the study with the industry. But a different picture emerges from emails and travel vouchers obtained by The New York Times under the Freedom of Information Act, as well as from interviews with former federal officials.
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Sunday, March 25, 2018

Sodium bisulfite is also added to leafy green vegetables in salad bars and elsewhere, to preserve apparent freshness, under names like LeafGreen. The concentration is sometimes high enough to cause severe allergic reactions.[12]

Thursday, March 15, 2018

Unfortunately, too many of those who seek to disrupt healthcare have dollar signs in their eyes, making it impossible for them to see and acknowledge their ignorance—their lack of any real insight in the daily practice of healthcare. Those with the practical experience to help shape a better system that integrates the potential efficiencies of telemedicine, machine learning, and big data with current practice patterns in order to provide efficient and high-quality care are too often relegated to the sidelines; changes are imposed upon them from above by people with no understanding of the potential unintended consequences of their unilateral decisions.

I believe the US healthcare system is poised for significant change in the coming years. This may be rudderless navigation directed overwhelmingly by profiteering individuals from a business and technology background, merely seeking a short-term exit strategy to maximize their wealth rather than a true transformation of healthcare in a meaningful, beneficial way. But there are new entrants in the healthcare arena who may have the more noble goal of creating a US healthcare system that truly works, rather than being dragged down by colossal inefficiencies and the deliberate foot-dragging of the incumbent stakeholders who benefit from this. The recently announced collaboration among Amazon, Berkshire Hathaway, and JP Morgan to create and demonstrate a path to efficient medical care in America[1] may have the needed power and, possibly, the long-term vision to execute on this promise.

To do so, it will be critical to welcome the participation not only of the medical dilettantes who consider themselves experts because they technically still see a few stray patients as a small fraction of their workweek, but the vast majority of working doctors who unfortunately remain an afterthought of far too many who expect to redefine how healthcare is delivered. At the same time, physicians who fit that bill and care for patients day to day should strive to play a more active role in these initiatives. We only have the right to not be shepherded around by those outside healthcare if we, as practicing physicians, are not complacent enough to act like sheep.

Whether for weight loss, muscle building, or simply as a convenient quick meal on the go, many Americans turn to protein powders and drinks.

But a new study shows that many of the top-selling powders and drinks may contain concerning levels of heavy metals such as arsenic, cadmium, mercury, and lead, and toxins like bisphenol A (BPA), a chemical found in some plastic containers and food can liners.

These substances have been linked to cancer, brain damage, and reproductive issues.

Thursday, March 8, 2018

The truth of the matter is that a large degree of America's love/hate relationship with doctors is fueled primarily by our idealized notion of what a doctor should be. When asked to describe their vision of an ideal doctor, patients often use such words as "empathetic," "wise," "confident," "attentive," "brilliant," "dedicated," and "altruistic." But they want trust, friendliness, respect, honesty, timeliness, and sincerity, too.

That's an awfully high pedestal. And these expectations extend to physicians' lives and behavior outside the office as well.

How did we get here? Once upon a time, long ago (before third parties inserted themselves into medicine), we had the doctor and the patient. Alone. In one room. Many times, in a bedroom during a house call. The relationship between doctor and patient was undisturbed by layers of bureaucracy, faxes, and phone trees, uncorrupted by superbills and CPT codes.

This fairy-tale physician—our savior in a white coat—who will come to our aid any time of day or night lives in our collective consciousness. Doctors yearn to be heroes, and suffering patients seek a savior. We fulfill each other's core needs. After all, without patients, doctors couldn't exist.

Tuesday, March 6, 2018

"ACP's analysis of the evidence behind existing guidelines found that treatment with drugs to targets of 7% or less, compared with targets of about 8%, did not reduce deaths or macrovascular complications, such as heart attack or stroke, but did result in substantial harms," said Jack Ende, MD, ACP president, in a statement.

"For most people with type 2 diabetes, achieving an HbA1c between 7% and 8% will best balance long-term benefits with harms such as low blood sugar, medication burden, and costs," he added.

By some measures, the people using non-opioid drugs such as Tylenol, ibuprofen and lidocaine experienced more pain relief than people using medications like morphine, Vicodin and oxycodone — though the differences weren't large enough to be considered statistically significant. Patients in both groups saw similar improvements in their quality of life.

Sunday, March 4, 2018

The results, published in The Lancet Diabetes and Endocrinology, showed the patients could be separated into five distinct clusters.

Cluster 1 - severe autoimmune diabetes is broadly the same as the classical type 1 - it hit people when they were young, seemingly healthy and an immune disease left them unable to produce insulin

Cluster 2 - severe insulin-deficient diabetes patients initially looked very similar to those in cluster 1 - they were young, had a healthy weight and struggled to make insulin, but the immune system was not at fault

Cluster 3 - severe insulin-resistant diabetes patients were generally overweight and making insulin but their body was no longer responding to it

Cluster 4 - mild obesity-related diabetes was mainly seen in people who were very overweight but metabolically much closer to normal than those in cluster 3

Cluster 5 - mild age-related diabetes patients developed symptoms when they were significantly older than in other groups and their disease tended to be milder

Saturday, March 3, 2018

Calcium supplementation alone more than doubled the risk for serrated sessile adenomas or polyps (SSA/Ps), and when combined with vitamin D, it almost quadrupled the risk, according to the results of a large randomized chemoprevention trial published online today in Gut.

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